Why Fear Free care starts before the exam room

A VETgirl podcast featuring IndyVets’ Dr. Erica Thiel and Fear Free executive Dr. Jennifer Merlo is reframing a point that’s increasingly central in companion animal practice: sedation isn’t a sign that a team has failed, but often a sign that the team is trying to prevent fear, anxiety, and stress before a visit escalates. The episode’s premise, “Sedation Isn’t Surrender: Why Fear-free Starts Before the Exam Room,” fits squarely within the wider Fear Free push to move emotional wellbeing upstream, into appointment prep, transport, intake, and handling plans, not just what happens once a pet is on the exam table. (fearfreepets.com)

That idea has been building for years. Fear Free, founded in 2016, says its mission is to prevent and alleviate fear, anxiety, and stress in pets, and the organization has expanded from certification into broader education, webinars, podcasts, and practice-level standards. AAHA’s coverage of Fear Free practice says more than 320,000 veterinary and pet professionals, animal welfare communities, and pet parents have registered for Fear Free programs and courses, underscoring how widely the framework has spread. (fearfreepets.com)

Clinically, the podcast’s theme is consistent with existing guidance. AAHA behavior-management resources say anxiolytic medications or sedatives can make veterinary visits less stressful and list options commonly administered by pet parents before the appointment, including benzodiazepines, gabapentin, trazodone, and clonidine. AAHA’s anesthesia guidance goes further, stating that anxiolytic drugs should definitely be administered for fractious, aggressive, or fearful patients, and strongly considered for those that show fear, anxiety, or stress during a hospital visit. The 2022 AAFP/ISFM feline interaction guidelines also describe pre-visit gabapentin and similar agents as tools to reduce fear-anxiety and improve compliance with examination. (aaha.org)

The industry backdrop is shifting, too. In November 2023, the FDA approved Bonqat, a pregabalin oral solution for the alleviation of acute anxiety and fear associated with transportation and veterinary visits in cats. According to the FDA, the product is given about 1.5 hours before transport or the visit, and in the registration field study, a little over half of treated cats had a good-to-excellent response during both transportation and the veterinary visit, versus about one-third of placebo-treated cats. That approval gave veterinarians a labeled option for a use case that had often relied on off-label protocols and individualized trialing. (fda.gov)

Public-facing and trade commentary has also helped normalize the conversation. AAHA’s 2024 reporting on Fear Free practices noted that preprescribed medications such as gabapentin may be given the night before and again shortly before an appointment, and quoted a veterinary assistant saying she tells hesitant pet parents that sedation can be appropriate because the pet is happier and less likely to retain a traumatic memory of treatment. Fear Free educational materials similarly emphasize that pre-visit pharmaceuticals, used alongside training and handling changes, are meant to reduce fear, anxiety, and stress, not simply “drug” the patient into submission. (aaha.org)

Why it matters: For veterinary professionals, this is really about standard of care, workflow, and safety. A practice that treats chemical restraint or pre-visit medication as a welfare tool rather than a defeat may be better positioned to complete exams, collect diagnostics, protect staff, and preserve the long-term relationship between the clinic and the pet parent. It also supports a more honest client conversation: some patients will never be low-stress with treats, mats, and gentle handling alone. For those animals, pre-visit pharmaceuticals, procedural sedation, or both may be what allows care to happen without compounding trauma. That has implications for compliance, revisit rates, and team morale, especially in high-volume general practice and relief settings. (aaha.org)

There’s also a regulatory and communication angle. FDA-approved products like Bonqat may make some pet parents more comfortable with the idea that fear associated with transport and veterinary visits is a legitimate clinical target. At the same time, most protocols still require individualized prescribing, informed consent, and careful patient selection, particularly when teams are using off-label combinations or managing geriatric, medically complex, or brachycephalic patients. Inference: as more clinics adopt Fear Free language, the differentiator won’t be whether they say they value emotional safety, but whether they operationalize it through history-taking, pre-visit questionnaires, transport advice, medication trials, and staff training. (fda.gov)

What to watch: The next step is likely less about a single new announcement and more about implementation, including broader use of structured pre-visit protocols, more discussion of labeled versus off-label anxiolytics, and continued debate over when Fear Free handling is enough and when sedation should be the default for a known high-FAS patient. (fearfreepets.com)